Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.
Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.
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DOI：
10.1097/00003246-200107000-00002
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发表时间：
2001-07-01
影响因子：
8.8
通讯作者：
Pinsky, M R
中科院分区：
文献类型：
--
作者：
Angus, D C;Linde-Zwirble, W T;Pinsky, M R
目的：确定美国严重脓毒症的发生率、成本和结局。设计：观察性队列研究。地点：美国7个州的所有非联邦医院（n = 847）。患者：所有患者（n = 192,980）符合《国际疾病分类》第九版《临床修改》的严重脓毒症标准。干预措施:没有。测量方法和主要结果：我们将来自7个大州的所有1995年州医院出院记录（n = 6,621,559）与来自美国人口普查、疾病控制中心、卫生保健融资管理局和美国医院协会的人口和医院数据联系起来。我们将严重脓毒症定义为记录感染和急性器官功能障碍，使用基于国际疾病分类，第九版，临床修改的标准。我们在五家医院的一个子集中根据前瞻性临床和生理学标准验证了这些标准。我们对全国年龄和性别调整后的发病率、成本和结果进行了估计。我们确定了192,980例，得出全国估计的751,000例（每1,000人口中有3.0例，每100家医院出院2.26例），其中383,000例（51.1%）接受了重症监护，另外130,000例（17.3%）在中间护理病房进行了通气或在冠状动脉护理病房接受了护理。发病率随年龄增长增加100倍（儿童为0.2/ 1000,85岁者为26.2/ 1000）。死亡率为28.6%，即全国215,000人死亡，并且随着年龄的增长而增加，从儿童的10%到85岁以上的38.4%。妇女的年龄特异性发病率和死亡率较低，但死亡率的差异可以用潜在疾病和感染部位的差异来解释。每个病例的平均费用为22100美元，全国每年的总费用为167亿美元。婴儿、非幸存者、重症监护病房患者、外科患者和器官功能衰竭患者的费用更高。预计发病率将以每年1.5%的速度增长。结论：严重脓毒症是一种常见、昂贵且经常致命的疾病，每年死亡人数与急性心肌梗死死亡人数一样多。这种病在老年人中尤为常见，而且随着美国人口老龄化，这种病可能会大幅增加。
OBJECTIVE: To determine the incidence, cost, and outcome of severe sepsis in the United States.DESIGN: Observational cohort study.SETTING: All nonfederal hospitals (n = 847) in seven U.S. states.PATIENTS: All patients (n = 192,980) meeting criteria for severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We linked all 1995 state hospital discharge records (n = 6,621,559) from seven large states with population and hospital data from the U.S. Census, the Centers for Disease Control, the Health Care Financing Administration, and the American Hospital Association. We defined severe sepsis as documented infection and acute organ dysfunction using criteria based on the International Classification of Diseases, Ninth Revision, Clinical Modification. We validated these criteria against prospective clinical and physiologic criteria in a subset of five hospitals. We generated national age- and gender-adjusted estimates of incidence, cost, and outcome. We identified 192,980 cases, yielding national estimates of 751,000 cases (3.0 cases per 1,000 population and 2.26 cases per 100 hospital discharges), of whom 383,000 (51.1%) received intensive care and an additional 130,000 (17.3%) were ventilated in an intermediate care unit or cared for in a coronary care unit. Incidence increased >100-fold with age (0.2/1,000 in children to 26.2/1,000 in those >85 yrs old). Mortality was 28.6%, or 215,000 deaths nationally, and also increased with age, from 10% in children to 38.4% in those >85 yrs old. Women had lower age-specific incidence and mortality, but the difference in mortality was explained by differences in underlying disease and the site of infection. The average costs per case were $22,100, with annual total costs of $16.7 billion nationally. Costs were higher in infants, nonsurvivors, intensive care unit patients, surgical patients, and patients with more organ failure. The incidence was projected to increase by 1.5% per annum.CONCLUSIONS: Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction. It is especially common in the elderly and is likely to increase substantially as the U.S. population ages.